"Havd.—No point of ossification in the bones of the carpus; those of the metacarpus and phalanges are regular as to form and direction. The size is above the normal.
"Pelvis. —Sufficiently regular at first, but the upper rim of the pubes is slightly elevated, hence there is considerable obliquity of the superior strait. Considerable increase in the transverse diameter, compared to the antero-posterior; pubes and ischio pubic rami cartilaginous, the other parts regularly ossified.
"Femora.—Curve is very marked, directed backward and inward. A second curve, with internal concavity and external convexity less pro nounced; extremities largely increased in size.
"Tibice.—Large and very short, very obliquely cut away at the upper part, from above downward and behind forward. Curve gentle, concavity backward and outward, convexity forward and inward. The lower ex tremity presents an analogous curve.
"Fibulw. —Placed more posteriorly than normal; slight curve, concavity anterior and internal; convexity, posterior and external; separated from the tibiEe by a large elliptical space. Normally large; much enlarged at the ends.
"Rd.—Tarsus completely cartilaginous, metatarsus and toes abnormally pssified and formed; feet incline outwards in relation to the leg.
"Vertebral Column. —Nothing unusual, spinous and transverse processes cartilaginous, with ordinary points of ossification.
"Periosteum.—Thin, regular, normally adherent." This description, which relates to a fcetus of seven and a half months, born alive, but respiration failed to be established, is typical and charac teristic. But in other cases different alterations are observed. In a case seen by Gukiot, and in another seen by myself (and whose skeleton is found in the MUROUM of the Clinic), the changes were identical. Besides the curves and the enlargements of the epiphyses, noted by Depaul, we found on the cranium an ossifie,ation more than iticomplete, characterized by some disseminated osseous plates, but all the long bones and the lower jaw presented an infinite number of fractures or solutions of continuity. Each bone seemed to consist of little osseous masses, mobile, bound to gether by the periosteum, which rendered the dissection very difficult.
But, contrary to the observations of Ganiot, in our case all the bones of the skeleton, vertebral column, pelvis, hands and feet, participated in the changes. Spiegelberg has found these same changes, and has seen the curves of the bone, the enlargement of the epiphyses, and the frac tures, with remarkable integrity of the clavicle. He noted: the flatten ing of the pelvis, the extension of the sacrum, the deviation of the prom ontory forward and downward, transverse flattening of the sacral vertebra3 and the iliac crests, increase of the pubic arch, the characteristic superior strait, and ossification, sometimes incomplete, sometimes almost exag gerated, of the cranium.
Depaul does not believe that these cases are teue instances of intra uterine rachitis, and holds that in ea,ch of the observations there has been. omitted mention of the sign which characterizes the second period of rachitis, namely, softening of the bony tissue; but, while extra-uterine rachitis rarely invades the whole skeleton, and has a predilection for the long bones, in so-called intra-uterkne rachitis the whole of the skeleton is invaded. Only the points of ossification which are in the spine appear as exceptions. The deformity is produced with a certain symmetry on the corresponding bones. Contrary to Spiegelberg's opinion, the curves are generally in relation with the muscular fiction, sometimes more mani fested inversely. Finally, there is no arrest of development.
In all probability, the affection began at a slightly advanced period of fietal life where as yet, only a little, if any, calcareous material had been deposited in the tissue. As a result, it is necessary to reject the idea of a deforznity succeeding a perfectly regular state, and to recognize the in fluence of a single cause, namely, an unequal distribution of the material which gives to the bones their form and their solidity. In short, in the true rachitis, the entire organism appears affected, while in the case of intra-uterine rachitis, the lesion appears exclusively confined to the bony system.